20040093.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PROPERTY TAX,7ACOUNT PARCEL NO.
172_� D (y) 0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
CGARAGE
RETAINING WALL
CARPORT
ROCKERY
[TYPE OF USE, BUSINESS OR ACTIVITW EXPAA
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DESCRIBE WORK TO BE DONE
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DATE CHECIJED BY
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd
EXISTING - PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT Undwground
Wifing required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 13 NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADEII I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMI 3 T ALLOWED PROPOSED ALLOWED OSED
LXP I I PROP
LOT COVERAGE REQUIRED SETBACKS (F7) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED
REMARKS
CHECKED BY
TYPE C
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OCCUPANT
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SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
JAREA
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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Description
Plan Check
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GLAZING %
LOT SLOPE %
Building Permit__7
PLAN CHECK NO:
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESOFIS
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECIiYOR INDIRECTLY
FROM I HE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOI BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Landscapelnsp.
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NOR Limi r IN ANY WAY THE CITYS ABILI`TY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, on THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGRiE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
(425)
NATU (0 0
DATE SIGNEU
771-0220
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FEE Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAF7�
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
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71 SIGNAT /MTE/
ctl�l S U# . *%
A17ENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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